Cargando…

Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3)

AIM: To compare the existing maternal and fetal outcomes in Asian Indian women with or without gestational diabetes mellitus (GDM) before the development of the Women in India with GDM Strategy (WINGS) GDM model of care (MOC). MATERIALS AND METHODS: Records of pregnant women were extracted retrospec...

Descripción completa

Detalles Bibliográficos
Autores principales: Mahalakshmi, Manni Mohanraj, Bhavadharini, Balaji, Maheswari, Kumar, Kalaiyarasi, Gunasekaran, Anjana, Ranjit Mohan, Ranjit, Unnikrishnan, Mohan, Viswanathan, Joseph, Kurian, Rekha, Kurian, Nallaperumal, Sivagnanam, Malanda, Belma, Kayal, Arivudainambi, Belton, Anne, Uma, Ram
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911838/
https://www.ncbi.nlm.nih.gov/pubmed/27366715
http://dx.doi.org/10.4103/2230-8210.183469
_version_ 1782438181516345344
author Mahalakshmi, Manni Mohanraj
Bhavadharini, Balaji
Maheswari, Kumar
Kalaiyarasi, Gunasekaran
Anjana, Ranjit Mohan
Ranjit, Unnikrishnan
Mohan, Viswanathan
Joseph, Kurian
Rekha, Kurian
Nallaperumal, Sivagnanam
Malanda, Belma
Kayal, Arivudainambi
Belton, Anne
Uma, Ram
author_facet Mahalakshmi, Manni Mohanraj
Bhavadharini, Balaji
Maheswari, Kumar
Kalaiyarasi, Gunasekaran
Anjana, Ranjit Mohan
Ranjit, Unnikrishnan
Mohan, Viswanathan
Joseph, Kurian
Rekha, Kurian
Nallaperumal, Sivagnanam
Malanda, Belma
Kayal, Arivudainambi
Belton, Anne
Uma, Ram
author_sort Mahalakshmi, Manni Mohanraj
collection PubMed
description AIM: To compare the existing maternal and fetal outcomes in Asian Indian women with or without gestational diabetes mellitus (GDM) before the development of the Women in India with GDM Strategy (WINGS) GDM model of care (MOC). MATERIALS AND METHODS: Records of pregnant women were extracted retrospectively from three maternity centers in Chennai. GDM was diagnosed using the International Association for Pregnancy Study Groups criteria or the Carpenter and Coustan criteria. Demographic details, obstetric history, antenatal follow-up, treatment for GDM, and outcomes of delivery were collected from the electronic medical records. RESULTS: Of the 3642 records analyzed, 799 (21.9%) had GDM, of whom 456 (57.1%) were treated with insulin and medical nutrition therapy (MNT), 339 (42.4%) with MNT alone, and 4 (0.5%) with metformin. Women with GDM were older than those without (28.5 ± 4.5 vs. 27.1 ± 4.5 years; P < 0.001) and had higher mean body mass index at first booking (26.4 ± 5.2 kg/m(2) vs. 25.2 ± 5.1 kg/m(2); P < 0.001). Rates of cesarean section (26.2% vs. 18.7%; P < 0.001), preeclampsia (1.8% vs. 0.8%; P = 0.04), and macrosomia (13.9% vs. 10.8%; P = 0.02) were significantly higher among women with GDM. In women with GDM treated with insulin and MNT, emergency cesarean section (16.2% vs. 36.6%; P < 0.0001), preeclampsia (0.7% vs. 3.2%; P = 0.015), and macrosomia (9.9% vs. 18.6%; P = 0.0006) were significantly lesser compared to those treated with MNT alone. CONCLUSION: Pregnancy outcomes were in general worse in GDM women. Treatment with insulin was associated with a significantly lower risk of complications. However, in countries with limited access to insulin and other medicines may lead to poor follow-up and management of GDM. Data from this retrospective study will form the basis for the development of the WINGS GDM MOC, which will address these gaps in GDM care in low-resource settings.
format Online
Article
Text
id pubmed-4911838
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Medknow Publications & Media Pvt Ltd
record_format MEDLINE/PubMed
spelling pubmed-49118382016-07-01 Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3) Mahalakshmi, Manni Mohanraj Bhavadharini, Balaji Maheswari, Kumar Kalaiyarasi, Gunasekaran Anjana, Ranjit Mohan Ranjit, Unnikrishnan Mohan, Viswanathan Joseph, Kurian Rekha, Kurian Nallaperumal, Sivagnanam Malanda, Belma Kayal, Arivudainambi Belton, Anne Uma, Ram Indian J Endocrinol Metab Original Article AIM: To compare the existing maternal and fetal outcomes in Asian Indian women with or without gestational diabetes mellitus (GDM) before the development of the Women in India with GDM Strategy (WINGS) GDM model of care (MOC). MATERIALS AND METHODS: Records of pregnant women were extracted retrospectively from three maternity centers in Chennai. GDM was diagnosed using the International Association for Pregnancy Study Groups criteria or the Carpenter and Coustan criteria. Demographic details, obstetric history, antenatal follow-up, treatment for GDM, and outcomes of delivery were collected from the electronic medical records. RESULTS: Of the 3642 records analyzed, 799 (21.9%) had GDM, of whom 456 (57.1%) were treated with insulin and medical nutrition therapy (MNT), 339 (42.4%) with MNT alone, and 4 (0.5%) with metformin. Women with GDM were older than those without (28.5 ± 4.5 vs. 27.1 ± 4.5 years; P < 0.001) and had higher mean body mass index at first booking (26.4 ± 5.2 kg/m(2) vs. 25.2 ± 5.1 kg/m(2); P < 0.001). Rates of cesarean section (26.2% vs. 18.7%; P < 0.001), preeclampsia (1.8% vs. 0.8%; P = 0.04), and macrosomia (13.9% vs. 10.8%; P = 0.02) were significantly higher among women with GDM. In women with GDM treated with insulin and MNT, emergency cesarean section (16.2% vs. 36.6%; P < 0.0001), preeclampsia (0.7% vs. 3.2%; P = 0.015), and macrosomia (9.9% vs. 18.6%; P = 0.0006) were significantly lesser compared to those treated with MNT alone. CONCLUSION: Pregnancy outcomes were in general worse in GDM women. Treatment with insulin was associated with a significantly lower risk of complications. However, in countries with limited access to insulin and other medicines may lead to poor follow-up and management of GDM. Data from this retrospective study will form the basis for the development of the WINGS GDM MOC, which will address these gaps in GDM care in low-resource settings. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC4911838/ /pubmed/27366715 http://dx.doi.org/10.4103/2230-8210.183469 Text en Copyright: © Indian Journal of Endocrinology and Metabolism http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution NonCommercial ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Mahalakshmi, Manni Mohanraj
Bhavadharini, Balaji
Maheswari, Kumar
Kalaiyarasi, Gunasekaran
Anjana, Ranjit Mohan
Ranjit, Unnikrishnan
Mohan, Viswanathan
Joseph, Kurian
Rekha, Kurian
Nallaperumal, Sivagnanam
Malanda, Belma
Kayal, Arivudainambi
Belton, Anne
Uma, Ram
Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3)
title Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3)
title_full Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3)
title_fullStr Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3)
title_full_unstemmed Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3)
title_short Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3)
title_sort comparison of maternal and fetal outcomes among asian indian pregnant women with or without gestational diabetes mellitus: a situational analysis study (wings-3)
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911838/
https://www.ncbi.nlm.nih.gov/pubmed/27366715
http://dx.doi.org/10.4103/2230-8210.183469
work_keys_str_mv AT mahalakshmimannimohanraj comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT bhavadharinibalaji comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT maheswarikumar comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT kalaiyarasigunasekaran comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT anjanaranjitmohan comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT ranjitunnikrishnan comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT mohanviswanathan comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT josephkurian comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT rekhakurian comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT nallaperumalsivagnanam comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT malandabelma comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT kayalarivudainambi comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT beltonanne comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3
AT umaram comparisonofmaternalandfetaloutcomesamongasianindianpregnantwomenwithorwithoutgestationaldiabetesmellitusasituationalanalysisstudywings3